Determining Payment Limits for Specified Provider-Based

70.2.2.1 – Determining Payment Limits for Specified Provider-Based RHCs with an AIR Established for RHC Services Furnished in 2020 (Rev. 11803; Issued: 01-26-23; Effective: 01-01-23; Implementation: 02-27-23) Beginning April 1, 2021, specified provider-based RHCs that had a per visit payment amount (that is, AIR) established for services furnished in 2020, the payment limit per visit shall be set at an amount equal to the greater of: 1. the per visit payment amount applicable to such RHC for services furnished in 2020, increased by the percentage increase in the MEI applicable to primary care services furnished as of the first day of 2021; or 2. the national statutory payment limit for RHCs per visit (see section 70.2.1 of this chapter). For subsequent years, the specified provider-based RHC’s payment limit per visit shall be set at an amount equal to the greater of: 1. the payment limit per visit established for the previous year, increased by the percentage increase in the MEI applicable to primary care services furnished as of the first day of such subsequent year; or 2. the national statutory payment limit for RHCs (see section 70.2.1 of this chapter). Note: For purposes of establishing the payment limit effective April 1, 2021 for specified provider-based RHCs defined in section 1833(f)(3)(A)(i)(I) of the Act, that is, had an AIR established for services furnished in 2020, MACs shall use the cost report ending in 2020 that reports costs for 12-consecutive months. If the RHC does not have a 12- consecutive month cost report ending in 2020, the MACs shall use the next available 12- consecutive month cost report that reports costs for RHC services furnished in 2020. MACs should not combine cost report data to equal a 12-consecutive month cost report.